RN Utilization Review jobs in California

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Clinical Appeals/Audit Specialist
Loma Linda University Medical Center - Murrieta - Murrieta, CA
Minimum of three years experience in case management or discharge planning, utilization review, or internal auditing required....
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Utilization Review Case Manager - FT/PT
Healthcare - Del Mar, CA
Part/Full time Utilization Review Coordinator to communicate substance abuse and mental health clinical information to managed care/insurance companies and...
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BH Care Manager I,ll,ll - LCSW, LMFT, RN - San Diego / Thous...
Anthem, Inc. 674 reviews - San Diego, CA
Current unrestricted license from the State of California as an LCSW, LMFT, RN required. Responsible for managing psychiatric and substance abuse or substance...
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Registered Nurse Case Manager

San Bernardino County 50 reviews - Colton, CA
$67,350 - $96,158 a year
Experience in Case Management, Managed Care or Utilization Review is highly desired. One (1) year of experience as a registered nurse in Case Management,...

Utilization Review Nurse

Medix 45 reviews - Los Angeles, CA  +2 locations
In need of a “Case Manager" to handle Utilization Review. It is critical that this person has experience in Utilization Review, CPT Coding, and knowledge of...

Senior Nurse Reviewer, Utilization - Remote U.S. based

Mitchell International, Inc. 2 reviews - California
Reviews requested treatment/procedures within Mitchell utilization review policies, URAC time frames or state-mandated timeframes (whichever is more restrictive...

Manager Utilization Management

Kaiser Permanente 2,827 reviews - Vallejo, CA  +1 location
Current California RN licensure. Manages projects related to chart reviews. Kaiser Permanente conducts compensation reviews of positions on a routine basis....

Clinical Appeals RN - Telecommute

UnitedHealth Group 2,445 reviews - Cypress, CA
Perform Pre-service utilization and concurrent reviews using Milliman criteria for Standard and Expedited Medicare member appeals in a fast-paced environment....

Care Coordinator

HealthCare Partners 110 reviews - Costa Mesa, CA 92626
Medical review as appropriate. Collects and prepares medical records for review. Review of requested services according to established guidelines and....

Manager Utilization Management - Sacramento, CA

UnitedHealth Group 2,445 reviews - Sacramento, CA 95828
RN, Registered Nurse, UR, UM, Utilization Review, Utilization Management, Concurrent Review, Milliman, Interqual, Managed Care, Insurance, Case Management, Case...

Continuing Care Utilization Review Coordinator, RN

Kaiser Permanente 2,827 reviews - San Jose, CA  +4 locations
Reviews utilization patterns, identifies trends and problems areas for special studies. Conducts utilization review for in-house patients and/or those members...

Inpatient Utilization Management Nurse

San Francisco Health Plan 7 reviews - San Francisco, CA
Prior experience in case management, resource management or utilization review preferred. San Francisco Health Plan is seeking a California Registered Nurse for...

Utilization Review Nurse

A New Start Treatment and Recovery Center 16 reviews - Los Angeles, CA 90034
Utilization review experience preferred but will train right candidate:. Complete all insurance and review documentation in timely manner....
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Interim Care Management Nurse Consultant
Clinical Management Consultants - San Rafael, CA
$139,057 - $151,672 a year
The Interim Consultant will oversee the functions associated with care facilitation, utilization review, and social work as well as the movement of patients...
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Clinical Appeals Coordinator
Sharp Healthcare 94 reviews - San Diego, CA
70443, Clinical Appeals Coordinator, Case Manager, RN Case Management, Utilization Review, Denial Management, Appeals, Audits, Quality, CCM, ACM, CPHQ, CPHM....
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As part of Loma Linda University Medical Center, we celebrate the healing ministry of Jesus Christ -- to make man whole.